Multiple studies have focused on the impact of maternal depression on mother-child interactions, children's behavior and development, and the subsequent risk for development of depression among children. Yet, little is known about the impact of maternal depression on service use for children. This may be an important gap in understanding service use for young children, if mothers experiencing depressive symptoms are less likely to seek preventive services or more likely to seek acute care for their children. It is widely recognized that currently, pediatricians do little to recognize maternal depression. This project relies on secondary analyses of data collected as part of the National Evaluation of the Healthy Steps for Young Children Program. Healthy Steps is a new model of pediatric practice that incorporates child development specialists and enhanced developmental services into routine pediatric care for all families of young children from birth to age 3 years. The Program is designed to strengthen parents' knowledge, attitudes, and behaviors in ways that promote their child's health and development. The primary objective of the proposed project is to assess whether the presence of maternal depressive symptoms is associated with children's receipt of health services (0-30 months). Study aims include: 1) To determine whether maternal depressive symptoms are associated with children's receipt of pediatric visits, hospitalizations, emergency department visits, referrals for behavioral/developmental concerns and immunizations; 2) To determine whether associations between maternal depressive symptoms and children's receipt of services vary depending on the timing of maternal depressive symptoms; and 3) To determine whether associations between maternal depressive symptoms and children's receipt of services vary depending on participation in Healthy Steps. The proposed study relies on: detailed records of children's health service use from birth to 30 months on a national sample of over 5000 children; repeated measures of maternal depressive symptoms from parent interviews obtained at 2-4 and 30-32 months; and a newborn questionnaire collected at the time of enrollment in Healthy Steps. Data will be analyzed using hierarchical regression models to generate overall estimates of the associations between maternal depressive symptoms and children's receipt of services and account for within site correlation of outcomes and possible covariates. This study will inform policy and practice regarding 'whether we should expect different patterns of service use for children living with mothers with depressive symptoms and whether participation in Healthy Steps modifies these relations.